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BioMed Research International
Volume 2015, Article ID 279890, 13 pages
Research Article

Comparative Effectiveness of Tocilizumab and TNF Inhibitors in Rheumatoid Arthritis Patients: Data from the Rheumatic Diseases Portuguese Register,

1Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Edifício Egas Moniz, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal
2Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Avenida Prof. Egas Moniz, 1649-028 Lisboa, Portugal
3Rheumatology Department, Hospital Garcia de Orta, Avenida Prof. Torrado da Silva, 2801-951 Almada, Portugal
4Rheumatology Department, Centro Hospitalar Universitário de Coimbra, Praceta Mota Pinto, 3000-076 Coimbra, Portugal
5Rheumatology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Rua da Junqueira 126, 1349-019 Lisboa, Portugal
6Rheumatology Department, Instituto Português de Reumatologia, R. Beneficência 7, 1050-034 Lisboa, Portugal
7Rheumatology Department, Unidade Local de Saúde do Alto Minho, Hospital Conde de Bertiandos, Largo Conde de Bertiandos, 4990-041 Ponte de Lima, Portugal
8Rheumatology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
9CEDOC, NOVA Medical School, Nova University, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal

Received 5 December 2014; Accepted 11 February 2015

Academic Editor: Guixiu Shi

Copyright © 2015 Vasco C. Romão et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. To compare the effectiveness of TNF inhibitors (TNFi) and tocilizumab in rheumatoid arthritis (RA) treatment, according to different response criteria. Methods. We included RA patients registered in the Rheumatic Diseases Portuguese Register treated with TNFi or tocilizumab for at least 6 months, between January 2008 and July 2013. We assessed remission/low disease activity (LDA) at 6 months according to DAS28, CDAI, and SDAI, as well as Boolean ACR/EULAR remission and EULAR response rate, adjusting for measured confounders. Results. Tocilizumab-treated patients () presented higher baseline disease activity and were less frequently naïve to biologics compared to TNFi users (). Multivariate logistic regression analysis including the propensity score for receiving tocilizumab showed that patients treated with tocilizumab were more likely to achieve remission or LDA according to DAS28 (OR = 11.0/6.2, 95% CI 5.6–21.6/3.2–12.0), CDAI (OR = 2.8/2.6, 95% CI 1.2–6.5/1.3–5.5), or SDAI (OR = 3.6/2.5, 95% CI 1.5–8.7/1.1–5.5), as well as a good EULAR response (OR = 6.4, 95% CI 3.4–12.0). However, both groups did not differ in Boolean remission (OR = 1.9, 95% CI 0.8–4.8) or good/moderate EULAR response (OR = 1.8, 95% CI 0.8–4.5). Conclusions. Compared with TNFi, tocilizumab was associated with greater likelihood of achieving DAS28, CDAI, and SDAI remission/LDA and EULAR good response. Boolean remission and EULAR good/moderate response did not differ significantly between groups.